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Fecal Transplant for Chron's

By Tracy Hampton, PhD BIDMC Correspondent

Published On: Nov 26 2013 05:57:16 PM EST

There are lots of different types of transplants for lots of different medical conditions. One of the newest is called a fecal transplant, where the stool of a healthy individual is transferred to the intestines of a person with an intestinal disorder. This treatment has had proven success for clearing infections with Clostridium difficile, a powerful bacteria that is difficult to treat. The strategy is thought to revert the bacterial make-up of a person’s intestines to its normal state, with harmless bacteria displacing pathogenic ones.

A handful of doctors have tried the procedure in the clinic for various conditions such as Crohn’s disease and ulcerative colitis, and numerous patients have tried home remedies using samples from family members or close friends. However, fecal transplants are still considered an investigational, or research, treatment, and it is unproven in patients with Crohn’s or ulcerative colitis.

Dr. Alan Moss, an Associate Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and his colleagues are currently conducting the first registered clinical trial that is testing the potential of fecal transplants in patients with Crohn’s disease. “Fecal transplants have certainly taken off in the last couple of years, and some doctors have anecdotally reported they’ve had success in treating Crohn’s disease this way. But we need clinical trial data to objectively test if it’s safe for these patients, and if it improves their condition,” he says. “There are a lot of unknowns in this field—whether fresh stool is better than frozen, which types of donors are associated with successful outcomes, which types of patients could respond etc.” This study is funded by a grant to the Harvard Institute of Translational Immunology from the Leona and Harry Helmsley Charitable Trust.

One of the patients in Dr. Moss’s trial, who wishes to remain anonymous, jumped at the chance to participate. “I’m against taking medicine since there can be many side effects, including unknown long term ones. I’ve been managing my disease with a very restrictive diet: unable to drink coffee or alcohol, eat salads, cheese, spicy foods, fried foods, chocolate, sugar, seeds, nuts...and these are just a few! The diet is so restrictive that it is difficult to maintain,” she says. “Once I was able to get over the gross details of the study, I became so intrigued by the process and excited about it.”

Pharmaceutical companies are also interested in fecal transplantation because if it’s successful, they might be able to isolate the active compounds in the therapy—such as important strains of bacteria or products of bacteria—that could be developed and commercialized. “Working with stool is cumbersome, to put it mildly,” says Dr. Moss. “So it might be easier to treat patients with only the key components of stool in a pre-packaged format.”

Dr. Moss notes that many people are trying fecal transplants at home with protocols they find online. “The most important thing to consider is the donor, who could carry unknown infections in their stool. A patient might feel safe with a donation from a spouse or other family member , but I really worry about people trusting strangers for untested donations outside of the clinical setting.” He even noted that some ads have been placed on Craigslist. “I certainly would discourage people from relying on home transplants using unscreened donor stool, because many viruses, bacteria, and parasites can be found in stool, ” he says. In clinical trials, donors undergo extensive health questionnaires and stool testing to reduce the risk of their stool harboring infections.

The patient in Dr. Moss’s trial is seeing good results so far. “I see this as a major breakthrough in medicine by treating patients naturally, and it makes perfect sense. I’ve been eating and drinking whatever I want, and the Crohn’s symptoms I typically would have at this time are either minimal or nonexistent—symptoms such as sharp pain in my colon, cramps, bleeding ulcers, lethargy, joint pain, and diarrhea.” She says she looks forward to the day when fecal transplants might be an affordable means of managing Crohn’s disease and perhaps other similar conditions.

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